Clindamycin

Clindamycin is a lincosamide antibiotic that inhibits bacterial protein synthesis by binding to the 23S ribosomal RNA of the 50S subunit of the bacterial ribosome. This binding prevents peptide bond formation and translocation of the nascent peptide chain, effectively halting protein synthesis. It is primarily bacteriostatic but may be bactericidal against susceptible organisms at high concentrations. Its three-dimensional structure resembles the 3'-ends of L-Pro-Met-tRNA and deacylated-tRNA during the peptide elongation cycle, acting as a structural analog that impairs peptide chain initiation.

Adult

Oral: 150-450 mg PO q6-8h (max 1.8 g/day). IV/IM: 600-1200 mg/day divided q6-12h (max 4.8 g/day IV for severe infections). C. difficile infection: 300 mg PO QID x 10-14 days (alternative to metronidazole/vancomycin).

Pediatric

Oral: 8-25 mg/kg/day divided q6-8h (max 1.8 g/day). IV/IM: 20-40 mg/kg/day divided q6-8h (max 4.8 g/day). Neonates <1 month: 5 mg/kg IV q8-12h.

Renal adjustment

No adjustment required (not renally eliminated; hemodialysis and peritoneal dialysis are NOT effective in removing clindamycin).

Hepatic adjustment

Severe hepatic impairment: monitor serum levels if available; may need dose reduction. No adjustment for mild-moderate hepatic impairment.

Geriatric

No specific adjustment; monitor for C. difficile diarrhea and renal function if co-morbid.

Max dose

1.8 g/day (oral); 4.8 g/day (IV); 600 mg/dose (IV)

• Hypersensitivity to clindamycin or lincomycin
• History of pseudomembranous colitis or ulcerative colitis
• Non-bacterial infections (e.g., most upper respiratory tract infections)
• Meningitis (does not adequately penetrate CSF)